Evidenzbasierte Prävention und Gesundheitsförderung

Evidence-based health promotion and education relies on the systematic and critical discussion of the best available research on the effectiveness of interventions. In the last decade, evidence-based reviews provided decisive proof for the effectiveness of health promotion and education. The approach is also capable of identifying high-quality interventions and deficiencies. Nevertheless, there is an ongoing dispute concerning the transfer of evidence-based medicine to health promotion and education. Arguments concern databases, research strategies, validity and practical applicability of results. A discussion of these issues suggests that the methodology of evidence-based medicine is pertinent and informative. Some adaptations for health promotion and education would make sense, though: contexts and characteristics of interventions should be documented and published in rather more detail in order to reach better causal models. Pre-post studies which are of particular importance for health promotion and education should be elaborated according to the psychological multi-trait multi-method strategy (multiple measurements, modelling of process levels, multidimensional operationalization of complex outcomes). All relevant knowledge including qualitative studies should be integrated into cycles of theory formulation and evidence testing. Finally, a reappraisal of expert opinion is proposed relying on specific criteria for the transparency and plurality of consensus procedures ruling out conflicts of interest.     

Prävention und Gesundheitsförderung in Lehrberufen

Background

The health and stress situations of teachers are different from those of individuals in other professions. Moreover, teachers also have an important responsibility for health promotion in our society.

Results

Based on results regarding the health and stress of teachers, as well as on our experiences in occupational medicine and schools, a system for prevention and health promotion was developed. Teachers need adequate occupational medical care that is adapted to the characteristics of the teaching profession. Furthermore, a team of experts for occupational medical care and supervision is needed; this team should comprise not only occupational medicine physicians but also professionals from related disciplines such as psychology (e.g., educational psychologists).

Conclusions

Occupational medical care for teachers includes the analysis and arrangement of physical, social, and organisational conditions as well as examination and advisory services for teachers so that they can fulfil their educational functions adequately. Such occupational medical care and supervision would not only provide early diagnoses and prevent illnesses but would provide a basis for promoting and maintaining teachers’ health and work ability in the long run. This would meet the current concept of health as well as the demands of public health promotion that have become increasingly important over the last years.     

Ethik in Prävention und Gesundheitsförderung

Background

As in curative medicine prevention and health promotion are often confronted with conflicting values, for example the values of individual freedom and health.

Method

On the basis of the sociological systems theory the basics of ethics in prevention and health promotion are elaborated and reflected with regard to ethical questions that are regularly discussed in practice.

Results

In the systems theoretic understanding presented here ethics is not a higher form of morale that determines how these value-conflicts are to be solved. Ethics is rather understood as an attitude that allows the professionals to ask concrete questions in concrete situations and to take the responsibility for the answers they find.

Conclusion

Since prevention and health promotion are often confronted with ethical questions it is vital that these questions are systematically discussed by everyone involved in the conception of projects.     

Qualität in Prävention und Gesundheitsförderung

Following the principles of participatory health research, a collaborative study was conducted by the German Federal Association for Prevention and Health Promotion (BVPG) and the Institute for Social Health at the Catholic University of Applied Sciences Berlin (KHSB). The purpose of the study was to create a framework for the members of the BVPG for taking joint action on developing the quality of health promotion and prevention measures. The 129 members of the BVPG are mainly nongovernmental organizations responsible for the implementation and coordination of prevention and health promotion interventions at the state and national levels. One of the explicit goals of the BVPG is to support the development of quality in prevention and health promotion. A theoretical sample was drawn of 14 member organizations to participate in individual interviews and a Delphi process to gather data on their current quality development practice, their need for further support, and their ideas for a common framework. Selected results from the interviews and the proposed framework are presented here.     

Klassifikationsmodelle in der Gesundheitsförderung und Prävention

Background

Various health classification models are used, particularly in the English-speaking world, to plan and evaluate projects and programs in the health sector. In this article, we critically examine two such models, which are currently being used in Switzerland.

Methods

We use the Model for Results Classification (by Health Promotion Switzerland) and the Program Logic Model (by Sue Funnell) as two types of classification models in order to examine their application for planning and evaluating health projects and programs. In addition, we clarify the various implications of classification systems within the health field and show, on the basis of two case studies, problems arising from their application.

Results

The models differ in their implicit assumptions and the extent to which they structure health-related categories, as well as in the degree of explication of causal reasoning with regard to health outcomes. An application of one or the other model will bring with it different advantages and disadvantages.

Conclusion

With regard to their limitations and inherent logic, classification models are nevertheless useful instruments to reduce complexity in planning and evaluating health projects and programs. Beyond that, they impose a negotiation between stakeholders with regard to making explicit health-related assumptions and goals.     

Gesundheitsförderung und Prävention im Setting Schule

Background

Social insurance agencies are important stakeholders in the field of school health promotion and prevention in Germany. Since 1989 the prevention regulations have given them various guidelines to support schools.

Objectives

Opportunities created by the new prevention law and the need for action to strengthen school health promotion and prevention are presented. The different positions of social insurance agencies will be elaborated based on the current situation of school health promotion and prevention in Germany.

Results

Schools are described as “social systems of learning”. Interventions on school health promotion and prevention that follow a comprehensive school approach are closely linked to educational school development. This position is also shared by the Standing Conference of the Ministers of Education and Cultural Affairs of the Laender in the Federal Republic of Germany. The social insurance agencies are required to cooperate and jointly establish goals. As a result, structured and systematic interventions on school health promotion and prevention have the potential to overcome a low level of cooperation, a lack of transparency and an often unclear level of intervention effectiveness.

Conclusion

It is expected that the new prevention law will give important impetus for further development of school health promotion and prevention (especially with regard to vulnerable groups) in terms of intervention quality and sustainability.

     

Potenziale pflegerischer Berufe in Prävention und Gesundheitsförderung

Background

The nursing profession hardly appears in current discussions and developments in prevention and health promotion in Germany. The reasons are manifold. Nursing in Germany is not prepared to tackle the developments in health politics and the health care system in order to fulfil the tasks and duties in prevention and health promotion. Concepts and theoretical basics as well as systematic knowledge are missing regarding which areas in Germany nurses are able to participate in an effective and beneficial way in prevention and health promotion.

Material and methods

Based on a systematic national and international literature search, potentials and preventive tasks of nurses in different health care systems are presented.

Findings and conclusion

The findings show that nurses in different countries are firmly anchored in health care systems. They are an integrated part of preventive programs. The integration of nursing professions in prevention and health promotion in the selected countries goes far beyond the German level.     

Schwerpunkte der Prävention und Gesundheitsförderung in Bayern

Background

Based on a parliamentary mandate a comprehensive survey on projects of health promotion and disease prevention was conducted in Bavaria.

Methods

Institutions and their umbrella organizations active in health promotion and disease prevention were contacted with a structured questionnaire via a snowball system.

Results

The main areas of activity among 1,280 projects that were active in 2004 were nutrition/physical activity, tobacco/alcohol/illegal drug dependencies, health resources, AIDS prevention and sexual activity, and clinical preventive services. The leading methods were counseling and provision of information. The main target groups were adults (24%), young people (17%), and children (12%). Few projects (<3%) focused specially on socially disadvantaged groups. Fewer than half of the projects had a documentation process in place, and less than one of four conducted a formal evaluation.

Conclusions

An improved culture of documentation and evaluation, formal networks among projects and institutions, and the assurance of the necessary local capacities and competencies are important areas for further development in this field.     

Der Landesaktionsplan zur Gesundheitsförderung und Prävention Mecklenburg-Vorpommern

In June 2008 the Ministry of Social Affairs and Health Mecklenburg-West Pomerania published the FSAP. The FSAP contains lines of action for the settings preschool, school, workplace/working life and municipality. This study focuses the development of health promotion and prevention (hpp) in MWP referring to ratings by members of the alliance for health in MWP (afh) and by members of public health departments. A retrospective questionnaire study was developed (i.e. evaluation of the situation of hpp in MWP in 2008 vs. 2010). Data were collected in autumn 2010. 24 members of the afh (response rate: 60 %) and 17 members of public health departments (response rate: 100 %) completed a questionnaire. The members of the afh in MWP evaluate the connectivity between the institutional players in MWP as significantly increased (referring to municipality: p?<?0.05). Members of public health departments rate the amount of low-threshold services and the connectivity between counselling centres in their city/municipality as significantly increased (p?<?0.01). The results should be related to objective data.     

Neues zur Gesundheitsförderung und Prävention im Betrieb

Background

The new Prevention Law includes important starting points to strengthen and to further develop occupational health promotion and prevention practices in Germany. A major impetus lies in the encouragement of specific and better collaboration of social insurance and other health policy players, in establishing corresponding structures and in the rearrangement of the financial basis.

Aims

The Prevention Law strengthens the development of health insurance services with respect to content and systematic orientation and evaluation.

Results

Opportunties for systematic development of different approaches and services in health promotion and prevention are fostered through the Prevention Law. It covers rules for intersectoral cooperation with the occupational safety and health system, which have been long overdue; finally, it aims at reducing gender inequality with regard to health promotion and prevention.

     

Evidenzbasierung: Theoriebildung und praktische Umsetzung in Prävention und Gesundheitsförderung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz -     

Gesundheitsförderung und Prävention als integrierende Aufgaben europäischer Politik

Background

The European integration poses a challenge for European health and social systems. Although the responsibility for health and social systems lies in the member states, the sovereignty of national actors is undermined by other European policies and by the jurisdiction of the European Court of Justice by applying the rules of the internal market to the health sector.

Aims

In this article general developments and problems of health policies and health promotion on a European level are outlined. This forms a basis to formulate the necessity for a public debate about a European social model and the necessity for action.

Conclusion

The concept of health promotion is introduced to structure this debate. The differentiation of political action areas and the participatory approach of health promotion opens up the possibility for a democratic re-formation of European health and social systems and to outline essential forms of a European social model.     

Sport als Mittel in Prävention, Rehabilitation und Gesundheitsförderung

Physical activities are particularly health effective when they are structured and systematically organized, for example, with respect to a dose–response relationship or to psychosocial aspects. Which insights can be gained from scientific knowledge on the structure of physical activities? Which health-related goals can be sought with different physical activities in the field of sport? Which target groups can be reached with these kinds of sport? These questions are addressed in this article on the basis of current scientific knowledge—to promote the development of health-enhancing physical activities especially in sport federations, but also to create a communication platform between the sport and the health sector. The work of researchers in this field is focused mainly on health-enhancing physical activity, but they are also engaged in health-related scientific organizations and in sport federations.     

Anforderungen an Qualitätssicherungsverfahren für Prävention und Gesundheitsförderung

Background

Quality enhancement regarding prevention, health promotion, and education is in a state of rapid development. Thus, requirements and expectations concerning the available approaches should be transparent so that the debate has a scientific basis and the different user groups’ perspectives are integrated.

Methods

A review-based questionnaire comprising 21 usability criteria in five comprehensive usability dimensions for quality assurance was designed. These dimensions were (1) easy and efficient handling, (2) scope of practical functions and options for usage, (3) completeness of data and reach of information, (4) compliance and motivation of users, and (5) scientific quality of results and data. Two hundred twenty-eight German experts assessed the criteria’s importance and compatibility. These experts represented different institutions as well as different hierarchical levels, professional tasks, and disciplines in order to vary the experience and perspective within the expert panel.

Results

The experts held almost all usability criteria to be important or very important. On a scale in which 1= very important and 5= unimportant, five items reached a mean below 1.5 (19%), 13 more items below 2.0 (50%), and seven more under 2.5 (27%). Thus, 18 items out of 26 (69%) were rated as important or very important, and seven items (27%) were rated as nearly just as important. The experts made only six proposals for additional criteria. They reported frequent clashes among the usability requirements; 94.3% of the experts reported incompability between the usability dimensions, mainly between easy handling and scientific quality (75.8% of the respondents) and between easy handling and completeness of data and reach of information (73.6%). Only 5.7% of the experts considered all usability requirements to be easily reconcilable. There was high homogeneity among experts from different disciplines, fields of work, and professional functions. Only one significant difference occurred between two groups; this concerned a single criterion, with small effect size.

Conclusion

The questionnaire provides a way to empirically investigate expectations of quality assurance systems. It may be used as a screening instrument or as a checklist to explore the preferences of users, stakeholders, and experts, for example, in Delphi processes or in the development of quality assurance systems and tools.     

Prävention und Gesundheitsförderung bei sozial benachteiligten Jugendlichen in berufsbildenden Schulen

Background

The major goal of this paper was to identify effective strategies for reducing the social and health-related disadvantages of deprived adolescents. The focus was on vocational schools. By means of a nationwide analysis, it was determined to what extent vocational schools are taken into consideration in the promotion of health-related prevention. In addition, providers of school-based health promotion were consulted as to which strategies might be suitable for reducing the social and health-related disadvantages of adolescents.

Results

It can be concluded that vocational schools are only marginally considered regarding intervention and projects for health-related prevention. Socially deprived adolescents in vocational preparation courses are not considered a target group at all. It was noted that the above mentioned individuals do not establish their realm of responsibilities within the vocational education system.

Conclusion

Reduction in social inequality is possible only if education and health care are taken into serious consideration.